Consumers Are Ready to Accept the Transition to Online and Electronic Records If They Can Be Assured of the Security Measures

Prajesh Chhanabhai, BSc, MSc, HINZ, ACM NZ Chapter; Alec Holt BSc, DipSci, MCom (Otago), MNZRS, PhD (Otago)

In This Article


In the health industry, the patient-doctor relationship is bound by trust -- trust that has stemmed from a clause in the Hippocratic Oath: "All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.[1]"

However, there is a shift in regard to one as a consumer rather than a patient. This change has seen a gradual transfer of responsibility from the doctor alone to both the doctor and the consumer, with the consumer now playing a greater role than in the past. This transition, coupled with the merging of information technology in to the health field, has aided in the shifting of attitudes from healthcare provider to consumer.[2]

The result of this merge has been the electronic health record (EHR). Pyper and colleagues[3] regard EHRs as a longitudinal record of the consumer's healthcare that has and is being provided to them. The aim is to establish a record that contains all consumer health information from "the cradle to the grave." However, as with Internet banking, consumers are very tentative about the process. The risks concerning security, privacy, and confidentiality are at the forefront of any concerns harbored by the consumer.[4]

With the move to increase the impact of technology in healthcare, the use of EHRs has become inevitable. Gillies and Holt[5] showed that it is only a matter of time before the paper-based record is converted into an electronic medium. Table 1 shows the functional comparison between the 2 types of record-storing methods. It can be seen that the case for EHRs is made stronger due to the inherent weaknesses of the paper-based system. However, even though healthcare professionals have seen its strength and the advantages are clear, EHRs face their stiffest barrier when it comes to acceptance by the health consumer.

The cornerstone of a good patient record system, without regard to the storage medium used, is reliability and security. Medical records contain a large amount of sensitive personal information. This information is, more often than not, continuous, extending from the cradle to the grave. It is broad, covering an extraordinary variety of detail, and with information technology it is more accessible than ever before. These records contain information that has nonmedical use, and access to that information could be of interest to many parties. For this reason, patients tend to expect that their communications and records with the clinicians and other healthcare providers will remain confidential. Annas[6] found that patients are not likely to disclose any intimate details freely unless they are certain that no one else, not directly involved in their care, will learn of them. This is the major fear that the health consumer today has with EHRs, as they may potentially be an impediment.

Earlier it was stated that the advantages of an EHR over the paper-based record should alone be a reason to move to the electronically based record. However, it is in one of the functional weaknesses of the paper-based record that the patient finds reassurance. The paper-based medium is cumbersome, yet it is in this that patients draw some sense of security. Its cumbersome nature minimizes the risk for breaches of confidentiality. Although a breach can occur, the magnitude of the breach is limited by the sheer difficulty of unobtrusively reviewing large numbers of records.[7] In the case of an electronic medium, breaches can occur in a less invasive manner, making them hard to detect and thus maybe more problematic.

Privacy is the main concern that health consumers are worried about with any records system. In 1995 the Louis Harris Poll found that 100% of Americans who were surveyed saw the benefits of having their health records computerized. However, 74% expressed concern about the negative effects of a computer-based system. Their concerns were based on the following points[8]:

  • Lack of understanding the dynamics of information gathering;

  • Fear of having a lack of control over the use of their personal information;

  • Not understanding the privacy protection laws and regulations that do and do not exist; and

  • Fear of errors, carelessness, and poor judgment by those who may handle their personal information.

These concerns stemmed from their previous experiences with computerized systems. Ten years down the line, in 2005, the Harris Interactive survey found that 48% of American adults claimed that the benefits to patients and their well-being outweighed any risks to privacy.[9] Nevertheless, almost 70% of these individuals were worried that sensitive health information may leak due to weak data security. The concerns now included[9]:

  • Sharing of medical information without the consumer's knowledge;

  • An increase in medical errors rather than a decrease with the use of computers;

  • Reduction of any existing privacy rules; and

  • Consumers not revealing all necessary information to their healthcare provider due to the fear of having their details being made available electronically.

The belief that EHRs are a good way to store records was shared by consumers who were surveyed by the National Health Service. Like their American counterparts, however, the British public also believed that security and privacy of their information were their major concern.[10] A report by the California Healthcare Foundation published in November 2005 indicated that 67% of participants surveyed were concerned about the privacy and security of their health information. This same survey indicated that 13% of consumers admitted that they practiced medical hiding behavior, a practice that is detrimental to the final healthcare plan of the patient.


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